同期或分期双侧全髋关节置换临床疗效及围手术期安全性综合比较Meta分析

Clinical efficacy and perioperative safety of simultaneous or staged bilateral total hip arthroplasty:A meta analysis

目的:使用Meta分析探讨同期或分期双侧全髋关节置换临床疗效及围手术期安全性。方法:制定相关检索式,对PubMed、Embase、Cochrane Library、知网、万方、维普数据库进行检索,时间设定为建库至2021年5月。筛选出所有主题与同期或分期双侧全髋关节置换相关的文献,根据纳入与排除标准,确定最终所纳入的文献,对文献质量进行评价,并使用Review Manager 5.3软件对所有指标进行Meta分析。结果:最终纳入22篇文献,包含3415例患者。Meta分析结果显示同期组住院时间明显少于分期组(MD=-9.99,95%CI(-14.72,-5.26),P<0.0001);同期组住院费用低于分期组(MD=-1.3,95%CI(-1.73,-0.86),P<0.00001);同期组手术时间少于分期组(MD=-27.08,95%CI(-40.89,-13.26),P=0.0001);同期组总出血量少于分期组(MD=-176.55,95%CI(-282.5,-70.6),P=0.001);同期组总输血量大于分期组(MD=69.85,95%CI(40.48,99.22),P<0.00001);同期组术后髋关节Harris评分高于分期组(MD=1.79,95%CI(0.8,2.79),P=0.0004);同期组并发症发生率低于分期组(OR=0.73,95%CI(0.56,0.96),P<0.05)。结论:相比较分期双侧髋关节置换,同期双侧髋关节置换在减少住院时间、节省住院费用、缩短手术时间、减少手术出血量等方面有优势,且能促进术后髋关节功能恢复,减少术后并发症,但总输血量增多。

Objective:To investigate the clinical efficacy and perioperative safety of simultaneous or staged bilateral total hip arthroplasty(THA)using meta-analysis.Methods:Relevant retrieval methods were developed to retrieve PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases,and the time was set to build the database until September 2020.All the literatures related to simultaneous or staged total hip arthroplasty were screened out.The final included literatures were determined according to the inclusion and exclusion criteria,and the quality of the literatures was evaluated.Meta analysis of all indexes was performed using Review Manager 5.3 software.Results:A total of 22 articles were included,including 3415 patients.Meta analysis results showed that the total hospitalization time in the simultaneous group was significantly lower than that in the staged group[MD=-9.99,95%CI(-14.72,-5.26),P<0.0001].Total hospitalization expenses in the simultaneous group were lower than those in the staged group[MD=-1.3,95%CI(-1.73,-0.86),P<0.00001].The operative time in the simultaneous group was less than that in the staged group[MD=-27.08,95%CI(-40.89,-13.26),P=0.0001].The total blood loss in the simultaneous group was less than that in the staged group[MD=-176.55,95%CI(-282.5,-70.6),P=0.001].The surgical transfusion volume in the simultaneous group was higher than that in the staged group[MD=69.85,95%CI(40.48,99.22),P<0.00001].Postoperative Harris score of hip joint in the simultaneous group was higher than that in the staged group[MD=1.79,95%CI(0.8,2.79),P=0.0004].The incidence of operative complications in the simultaneous group was lower than that in the staged group[OR=0.73,95%CI(0.56,0.96),P<0.05].Conclusion:Compared with staged bilateral total hip replacement,simultaneous bilateral total hip replacement has advantages in terms of reducing hospitalization time,saving hospitalization expense,shortening operation time and reducing surgical bleeding amount,and can promote postoperative hip function recovery,reduce postoperative complications,but increase total blood transfusion volume.